Abstract 2927: Coronary Flow Reserve as the Robust Prognostic Parameter of Echocardiography in Patients With Non-ischemic Chronic Heart Failure
Background: Echocardiography is a first-line tool to diagnose an anatomical, functional and hemodynamic abnormalities in patients with congestive heart failure. Recent advances of Doppler echocardiography provide an accurate noninvasive estimation of hemodynamic and coronary microcirculatory abnormalities in these patients.
Aim: This study was aimed to clarify the most robust echocardiographic predictor for the outcome in patients with non-ischemic chronic heart failure.
Methods: Echocardiography was performed with Sequoia 512 in 52 consecutive patients with non-ischemic chronic heart failure (mean age 68+/−12 years, NYHA II-III) including 34 in dilated cardiomyopathy and 18 with diastolic heart failure. Ischemic cardiomyopathy, chronic atrial fibrillation and predominant valvular heart disease were excluded. We obtained conventional 2D parameters such as left atrial or ventricular volume and left ventricular ejection fraction (EF), and Doppler parameters from mitral and pulmonary venous flow. Using tissue Doppler imaging, peak early diastolic velocity (Em) and intraventricular wall motion delay of septal and lateral mitral annulus, were estimated. In addition, coronary flow reserve (CFR) was measured in the distal portion of left anterior descending coronary artery as our previous reports have demonstrated. Simultaneously, serum levels of hemoglobin, creatinine (sCre) and plasma levels of BNP were also measured.
Results: At baseline, the mean values of EF, E/Em, CFR and plasma BNP levels were 37.5 %, 12.1, 2.4 and 192 pg/ml, respectively. CFR was significantly associated with sCre and Ln BNP (p < 0.05 for all). During the follow up periods (16+/−8 months), 10 patients had cardiac events (one patient with cardiac death and 9 patients with hospitalization for worsening heart failure). According to a multivariate stepwise analysis, CFR was the independent echocardiographic predictor of cardiac events in this study population (beta = −0.611, p < 0.01).
Conclusion: CFR was restricted in patients with non-ischemic chronic heart failure despite of normal epicardial coronary trees. CFR could be a robust echocardiographic predictor for future cardiac events in these patients.